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Evaluation of Eeg Pattern and Seizure Types of Genetic Dysmorphic Syndromes: Report of 50 Patients and Review of the Literature
Gürkan Gürbüz,
Filiz Hazan,
Selvinaz Edizer,
Bahar Toklu Baysal,
Ünsal Yilmaz,
Aycan Ünalp
Issue:
Volume 6, Issue 5, September 2018
Pages:
86-93
Received:
8 July 2018
Accepted:
23 July 2018
Published:
20 August 2018
Abstract: Many chromosomal anomalies manifest with epilepsy. Only few typical EEG and seizure type have been identified in genetic syndromes. Identification of typical seizure and EEG findings of certain genetic syndromes may serve as a guide for genetic analysis. This study aims to find typical EEG paterns of spesific genetic syndromes. The study enrolled 50 patients aged 0-16 years with a diagnosis of epilepsy and genetic syndrome in between 2014-2017 at the Dr. Behçet UZ Children’s Hospital Pediatric Neurology and Medical Genetics departments. Patients' characteristics and dysmorphic features were retrieved from Medical Genetic outpatient clinic patient files, while seizure type, epileptic syndromic classification, EEG and brain MRI findings, age at onset and frequency of seizure were determined from pediatric neurology follow-ups. Fifty patients (29 girls) with a mean age of 6.52 ±3.67 years (max=16, min=1) were enrolled. Twenty-two patients had microdeletion-duplication (44%), 12 had chromosomal anomalies (24%) and 16 had monogenic syndrome (32%). Pathology was present in the EEGs of 40 patients (80%). Focal epileptic disorder was determined in 28 subjects (56%), epileptic encephalopathy in 7 (14%), and generalized epileptic disorder in 5 (10%) Identification of seizure type and EEG pattern specific to each genetic dysmorphic syndrome may give clues to clinicians in recognizing these syndromes. However, in order to detect other specific EEG patterns, there is a need for multicentre studies with more patients.
Abstract: Many chromosomal anomalies manifest with epilepsy. Only few typical EEG and seizure type have been identified in genetic syndromes. Identification of typical seizure and EEG findings of certain genetic syndromes may serve as a guide for genetic analysis. This study aims to find typical EEG paterns of spesific genetic syndromes. The study enrolled 5...
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Pulmonary Alveolar Microlithiasis and Rheumatoid Arthritis with Pulmonary Tuberculosis
Arti Sharma,
Abhay Uppe,
Shahid Patel,
Girija Nair
Issue:
Volume 6, Issue 5, September 2018
Pages:
94-98
Received:
27 June 2018
Accepted:
23 July 2018
Published:
24 August 2018
Abstract: Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disease, characterised by widespread intra-alveolar accumulation of microliths. A 30-year-old male patient, known case of rheumatioid arthritis on treatment, presented with occasional complaints of cough with expectoration, since 1 year. He was found to be sputum AFB positive for which AKT was started, and a chest xray was advised, which showed diffuse bilateral micronodular calcific opacities having sand-like appearance distributed throughout the lungs, with a evident black pleural sign, which made us suspect PAM. An HRCT chest showed, multiple dense micronodular opacities in bilateral lung parenchyma prominently in the middle and lower lung zones giving a classical sandstorm appearance with sparing of a thin peripheral subpleural rim of parenchyma, giving a black pleura sign. The patient was symptomatically treated and was counselled for lung transplant and presents for regular follow up.
Abstract: Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disease, characterised by widespread intra-alveolar accumulation of microliths. A 30-year-old male patient, known case of rheumatioid arthritis on treatment, presented with occasional complaints of cough with expectoration, since 1 year. He was found to be sputum AFB positive for...
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The Pharmacological Action of Common Herbal Remedies
Rashid Bhikha,
John Glynn
Issue:
Volume 6, Issue 5, September 2018
Pages:
99-107
Received:
2 July 2018
Accepted:
27 July 2018
Published:
24 August 2018
Abstract: Acceptance of the clinical efficacy and tolerance of herbal remedies by practitioners of conventional, Western medicine is strongly dependent on unambiguous and reproducible evidence, particularly their pharmacological action. A single conventional drug generally has one dominant pharmacological mode of action which accounts for its therapeutic efficacy, whereas a herbal remedy because of the various active agents it contains, generally influences several biochemical and/or physiological systems present in the body. Identifying this therefore poses several challenges. They are much more complex, and the active components of a herbal remedy may act synergistically or interact in other ways. Although the need to determine modes of action has not been a primary concern of complementary healthcare practitioners, there is increasing pressure to elaborate objectively on their pharmacological action. In response, there has been an encouraging, and escalating, release of scientific data documenting the mode of action of many herbal remedies. Some we know about in considerable detail; of others we have an inkling; but for the vast majority the’ modes of action remain to be elucidated. This brief review, based on a survey of the available scientific and clinical literature, examines the modes of action of several therapeutic herbs which are being increasingly used, whether informally or as part of complementary or integrative medical practice. It examines a major category of sub stances, the adaptogens, and the various chemical forms it embraces, such as the saponins and triterpenes. The herbs with modulate the immune system, for instance garlic, turmeric and St John’s Wort, are likewise surveyed, as are the alkaloids and botanical anti-inflammatory agents. Herbs which exert pharmacological action via their nitric oxide regulatory properties are listed, as are those which provide essential micro-nutrients, such as vitamins and certain minerals. The review concludes with comment on the importance of understanding herbal remedy modes of action as a positive step to their wider adoption in the modern-day therapeutic armamentarium.
Abstract: Acceptance of the clinical efficacy and tolerance of herbal remedies by practitioners of conventional, Western medicine is strongly dependent on unambiguous and reproducible evidence, particularly their pharmacological action. A single conventional drug generally has one dominant pharmacological mode of action which accounts for its therapeutic eff...
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Effects of Statins on the Hepatic Decompensation, Mortality, Complications and Drug Safety in Liver Cirrhosis: A Systematic Review and Meta-Analysis
Xinxing Tantai,
Longbao Yang,
Zhongcao Wei,
Cailan Xiao,
Lirong Chen,
Jinhai Wang,
Na Liu
Issue:
Volume 6, Issue 5, September 2018
Pages:
108-120
Received:
13 July 2018
Accepted:
26 July 2018
Published:
31 August 2018
Abstract: Background and Aim: Evidence indicates statins seem to improve outcomes in cirrhotic patients. Systematic review and meta-analysis are performed to evaluate the effect and safety of statins in the setting of cirrhosis. Methods: We searched PubMed, EMBASE, and the Cochrane Library from inception through January 2018 to identify comparative studies evaluating the role of statins in cirrhosis. Pooled risk estimates with 95% confidence intervals were calculated using a random effects model. Results: Eight studies (4 retrospective cohort studies and 4 randomized controlled trials) involving 3,966 cirrhotic patients were included. Statin use was associated with 56% lower risk of progression to decompensated cirrhosis (RR, 0.44; 95% CI, 0.36–0.54) and 47% lower risk of mortality (RR, 0.53; 95% CI, 0.47–0.61). Subgroup analyses showed that these results were generally consistent regardless of study design, etiology of cirrhosis, stage of cirrhosis, follow-up time, method of identifying cirrhosis. For initial variceal bleeding, pooled RR was 0.48 (0.35–0.67). For ascites, pooled RR was 0.66 (0.45–0.99). For portal hypertension, using statins could increase the HVPG response rate, pooled RR was 2.61(1.03–6.62). For hepatocellular carcinoma, pooled RR was 0.47(0.36–0.63). For any adverse event and serious adverse events, using statins was almost equivalent to nonusers, pooled RR was 1.06 (0.50-2.25) and 0.77 (0.31–1.95). Conclusions: Statin use may be associated with reduced risk of hepatic decompensation and mortality in cirrhosis with well tolerated. Additionally, statin use appears to decrease portal hypertension and reduce the risk of initial variceal bleeding, ascites and hepatocellular carcinoma. Further RCTs will be required to confirm our findings.
Abstract: Background and Aim: Evidence indicates statins seem to improve outcomes in cirrhotic patients. Systematic review and meta-analysis are performed to evaluate the effect and safety of statins in the setting of cirrhosis. Methods: We searched PubMed, EMBASE, and the Cochrane Library from inception through January 2018 to identify comparative studies e...
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Frequency, Epidemiology and Outcome of Acute Kidney Injury Among Patients Admitted to Nephrology Center, Sana’a: Observational Study
Nagib Wazae Abuasba,
Khalid Alwadee,
Mushtaq Hasan Al-Hamadi
Issue:
Volume 6, Issue 5, September 2018
Pages:
121-125
Received:
11 July 2018
Accepted:
24 July 2018
Published:
3 September 2018
Abstract: Although acute kidney injury (AKI) in our setting is growing rapidly, the available data on the magnitude of this lethal problem are very limited. The objective of this study was to determine the incidence, epidemiology and outcome of AKI. A total of 143 hospitalized patients with AKI in Al Thawra General Hospital, nephrology department between July 2015 and December 2016 were enrolled. The mean age of the study population was 37.7 ± 8.4 years, and 68.5% of these patients were males. Almost 81.8% of cases were medically referred and malarial infection was the commonest cause of AKI (23%). Pre renal AKI was present in 65 patients (45.4%) and renal AKI in 78 patients (54.5%). Most cases were presented with clinical manifestation of volume overload (65%), oliguria (51.7%), anuria (16.7%), and high serum creatinine level. The majority of cases (58.7%) had recovered without dialysis. In-hospital mortality was observed in 11 patients (7.7%). Hepatic failure and malarial infection were the common causes of death. This study demonstrates low frequency of AKI in our setting. The etiologies of this lethal health problem are preventable and treatable in approximately half of cases. Late referral to hospital may contribute both to the progression of renal disease and also to high mortality.
Abstract: Although acute kidney injury (AKI) in our setting is growing rapidly, the available data on the magnitude of this lethal problem are very limited. The objective of this study was to determine the incidence, epidemiology and outcome of AKI. A total of 143 hospitalized patients with AKI in Al Thawra General Hospital, nephrology department between Jul...
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A Comparison of One Shape and ProTaper Next Rotary Systems for Elimination of Enterococcus Faecalis from Root Canal: Microbiological and SEM Evaluation
Renu Bala Sroa,
Baljeet Sidhu,
Sangeeta Aggarwal,
Aakanksha Chopra,
Angelina Bedi
Issue:
Volume 6, Issue 5, September 2018
Pages:
126-131
Received:
13 June 2018
Accepted:
24 July 2018
Published:
17 September 2018
Abstract: Incomplete removal of micro- organisms from infected root canals is a common cause of failed endodontic treatment. The difficulty in eradication of Enterococcus faecalis from root canals plays an essential role in pathogenesis of persistent pulpal and periradicular infections. The aim of the present study was to compare the reduction of Enterococcus faecalis in root canals by mechanical instrumentation using two rotary systems (One Shape and ProTaper Next) and Hand K-file instrumentation by using microbiological and Scanning Electron Microscopy (SEM) evaluation. Fifty one freshly extracted mandibular premolars with a single root were collected. After pre- instrumentation sampling, they were divided into three groups, Group A, Group B and Group C in which biomechanical preparation was done using Hand K- File, OneShape and Protaper Next respectively. Reduction in pre- instrumentation and post- instrumentation values of Enterococcus faecalis were analysed using microbiological and SEM evaluation. Statistical analysis by paired ‘t’ test and p value showed that there was highly statistical significant difference in CFU count reduction between the pre-instrumentation and post-instrumentation values in all the groups (p<0.001). Statistical analysis by Kruskal-Wallis Test and Mann-Whitney Test showed that at 1mm and 3mm level, Group A (Hand K-File) scored significantly higher value followed by Group B (OneShape Apical) and Group C (ProTaper Next). The most effective instrumentation technique in eliminating Enterococcus faecalis from the root canal was ProTaper Next system in comparison to OneShape Apical and Hand K-File.
Abstract: Incomplete removal of micro- organisms from infected root canals is a common cause of failed endodontic treatment. The difficulty in eradication of Enterococcus faecalis from root canals plays an essential role in pathogenesis of persistent pulpal and periradicular infections. The aim of the present study was to compare the reduction of Enterococcu...
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Pattern of Antimicrobial Resistance to Escherichia Coli Among the Urinary Tract Infection Patients in Bangladesh
Goutam Kumar Acherjya,
Keya Tarafder,
Rina Ghose,
Din Ul Islam,
Mohammad Ali,
Nazma Akhtar,
Rajashish Chakrabortty,
Satya Ranjan Sutradhar
Issue:
Volume 6, Issue 5, September 2018
Pages:
132-137
Received:
21 July 2018
Accepted:
14 August 2018
Published:
10 October 2018
Abstract: Urinary Tract Infection (UTI) is very common in our day-to-day clinical practice. Among all the organisms Escherichia coli (E coli) is the most common but antimicrobial resistance becomes an alarming issue for UTI management now a days. Aim of this study is to assess the pattern of antimicrobial resistance to E coli among the UTI patients in Jashore, Bangladesh. This observational study was conducted from February, 2017 to January, 2018 in the district of Jashore, Bangladesh. We recruited 696 patients of both sex with UTI only infected by E coli. We had excluded the patients with UTI caused by other than E coli, female during menstruation, pregnancy, history of taking antibiotics within last 21 days, catheterization within 1 month and pelvic organ & genito urinary tract surgery within 6 months. Evaluation of antimicrobial resistance was done according to the standard bacteriological methods. Mean age of our study cases was 41.46±17.21 years with the range from 15 to 91 years. More than 85% participants were female with a sex ratio was 8:1.5. Reproductive age group ranged from 21 to 50 years was affected most commonly which constituted approximately two-third of our study. Our study revealed that the maximum antimicrobial resistance to E coli was Cotrimoxazole (95.0%), followed by Ceftazidime (75.7%), Gentamicin (70.3%), Amikacin (69.0%), Imipenam (58.9 %,), Cefixime (58.0%), Ciprofloxacin (57.3%), Azithromycin (56.0%), Cefuroxime (46.6%), Cefotaxime (37.4%), Ceftriaxone (35.2%), Meropenem (32.2%), Nitrofurantion (4.7%). With the high magnitude of antimicrobial resistance to E coli among the UTI patients even with extended generation of Cephalosporins, Carbapenams, Ciprofloxacin, Cotrimoxazole, Azithromycin and Aminoglycosides, our recommendation as first line empirical treatment option in UTI should be Nitrofurantoin due to low resistance pattern.
Abstract: Urinary Tract Infection (UTI) is very common in our day-to-day clinical practice. Among all the organisms Escherichia coli (E coli) is the most common but antimicrobial resistance becomes an alarming issue for UTI management now a days. Aim of this study is to assess the pattern of antimicrobial resistance to E coli among the UTI patients in Jashor...
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Radiocontrast-Induced Acute Kidney Injury Following Coronary Angiography and Percutaneous Coronary Intervention: A Retrospective Cohort Study
Van Bui Pham,
Quang Dung Nguyen,
Nghia Huynh Thi Nguyen,
Thanh Phuong Pham Nguyen,
Thanh Liem Vo,
Minh Cuong Duong
Issue:
Volume 6, Issue 5, September 2018
Pages:
138-143
Received:
22 August 2018
Accepted:
10 September 2018
Published:
10 October 2018
Abstract: Despite the remarkable technological advances in coronary angiography (CA)/percutaneous coronary intervention (PCI) for diagnosis and treatment of coronary artery disease, the contrast-induced acute kidney injury (CI-AKI) is always an important cause of hospital-acquired AKI. Most local CI-AKI studies in Vietnam had small sample sizes and short-term follow-up of only 24-48 hours following CA or PCI intervention, resulting in controversial conclusions. We conducted a study of the incidence of CI-AKI during a longer follow-up time period and associated risk factors among adult patients undergoing CA/ PCI at Nguyen Tri Phuong University Public Hospital and Tam Duc Private Cardiology Center in Ho Chi Minh City, Vietnam between January 2014 and March 2015. All 320 patients with CA/PCI at the two hospitals were enrolled in a retrospective cohort study. Information on demographic data, treatment, and laboratory test results was collected from the patients’ records. The total cumulative incidence of CI-AKI at 24, 48, 72 and ≥72 hours following CA/PCI was 6.7%, 12%, 14% and 16.9% respectively. Prognostic factors for CI-AKI included an increase by 1 ml/min/1,73m² in clearance creatinine before the intervention (P = 0.006, Hazard Ratio (HR) = 0.970, 95%CI 0.949 – 0.991) and an increase by 1% in ejection fraction (P = 0.023, HR = 0.984, 95%CI 0.970 – 0.998). Delayed CI-AKI was not rare after CA/PCI intervention. Therefore, it is pivotal to monitor serum creatinine in a longer time after the intervention to timely detect CI-AKI. Also, information on risk factors such as emergency interventions, chronic kidney disease, and ejection fraction < 45% could assist in predicting CI-AKI development.
Abstract: Despite the remarkable technological advances in coronary angiography (CA)/percutaneous coronary intervention (PCI) for diagnosis and treatment of coronary artery disease, the contrast-induced acute kidney injury (CI-AKI) is always an important cause of hospital-acquired AKI. Most local CI-AKI studies in Vietnam had small sample sizes and short-ter...
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